Myocardial protection: comparing histological effects of single-dose cardioplegic solutions-study protocol for a secondary analysis of the CARDIOPLEGIA trial.

Background: Myocardial protection is crucial for successful cardiac surgery, as it prevents heart muscle damage that can occur during the procedure. Prolonged hypoxia without proper protection can lead to adenosine triphosphate consumption, microvilli loss, blister formation, and edema. Custodiol, del Nido, and modified del Nido are single-dose cardioplegic solutions with proven safety and significance in modern surgery. While each has been independently assessed for patient outcomes, limited research directly compares them. This study aims to compare their myocardial protection using histological analysis. Methods: In a double-blind clinical trial, at least 90 patients will be randomly assigned to receive one of the three cardioplegic solutions. Myocardial biopsies will be collected before cardiopulmonary bypass and 15 minutes after reperfusion. The surgical, anesthetic and perfusion techniques will be the same for all patients, following the Institution's standard protocols. Discussion: The ideal cardioplegic solution does not exist, and its selection remains challenging for surgeons. In modern surgical practice, understanding the behavior of these solutions and the ischemic tissue damage caused during induced cardiac arrest allows for safer surgical procedures. The results of this clinical trial can help in understanding the behavior of cardioplegic solutions and their tissue effects. Thus, by selecting the best cardioplegic solution, ischemic damage can be minimized, enhancing the effectiveness of this essential technique in cardiac procedures. The study may aid in implementing clinical protocols in several institutions, aiming to choose the solution with a superior myocardial protection profile, increasing safety, and reducing expenses. Trial Registration: Brazilian Clinical Trials Registry (ReBEC, http://ensaiosclinicos.gov.br/): RBR-997tqhh. Registered: January 26th, 2022.

Conventional Versus Minimally Invasive Aortic Valve Replacement Surgery: A Systematic Review, Meta-Analysis, and Meta-Regression.

Objective: To assess the potential benefits of minimally invasive aortic valve replacement (MIAVR) compared with conventional AVR (CAVR) by examining short-term outcomes. Methods: A systematic search identified randomized trials comparing MIAVR with CAVR. To assess study limitations and quality of evidence, we used the Cochrane Risk of Bias tool and GRADE and performed random-effects meta-analysis. We used meta-regression and sensitivity analysis to explore reasons for diversity. Results: Thirteen studies (1,303 patients) were included. For the comparison of MIAVR and CAVR, the risk of bias was judged low or unclear and the quality of evidence ranged from very low to moderate. No significant difference was observed in mortality, stroke, acute kidney failure, infectious outcomes, cardiac events, intubation time, intensive care unit stay, reoperation for bleeding, and blood transfusions. Blood loss (mean difference [MD] = -130.58 mL, 95% confidence interval [CI] = -216.34 to -44.82, I2 = 89%) and hospital stay (MD = -0.93 days, 95% CI = -1.62 to -0.23, I2 = 81%) were lower with MIAVR. There were shorter aortic cross-clamp (MD = 5.99 min, 95% CI = 0.99 to 10.98, I2 = 93%) and cardiopulmonary bypass (CPB) times (MD = 7.75 min, 95% CI = 0.27 to 15.24, I2 = 94%) in the CAVR group. In meta-regression analysis, we found that age was the variable with the greatest influence on heterogeneity. Conclusions: MIAVR seems to be an excellent alternative to CAVR, reducing hospital stay and incidence of hemorrhagic events. Despite significantly greater aortic cross-clamp and CPB times with MIAVR, this did not translate into adverse effects, with no changes in the results found with CAVR.

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial.

INTRODUCTION: Myocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study. METHODS AND ANALYSIS: This is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters. ETHICS AND DISSEMINATION: This protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field. TRIAL REGISTRATION NUMBER: RBR-7g5s66.

Trombosis muy tardía de stent Taxus en relación con una prueba de esfuerzo limitada por síntomas / Very late taxus stent thrombosis and symptom-limited exercise testing

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[Randomized trial of three regimens to prevent tuberculosis in HIV-infected patients with anergy]. / Ensayo clínico aleatorizado de tres aputas de quimioprofilaxis para prevenir la tuberculosis en pacientes infectados por el VIH con anergia cutánea.

INTRODUCTION: To evaluate the efficacy of three regimens of prophylactic therapy for tuberculosis in HIV-infected patients with anergy. METHODS: Prospective, multi-center, randomized, comparative, and open clinical trial. Anergy was defined as absence of induration in response to three antigens (PPD, Candida albicans and parotiditis antigen) applied by the Mantoux method. Patients were randomized into one of the following prophylactic treatment groups: isoniazid for six months (6H), rifampin plus isoniazid for three months (3RH), rifampin plus pyrazinamide for two months (2RZ) or no treatment (NT). After completion of treatment, patients were followed up for two years. RESULT: A total of 319 patients were included in the study, 83 in the 6H regimen, 82 in 3RH, 77 in 2RZ and 77 in NT. The observation period following treatment was 88, 96, 81 and 126 person-years, respectively, for 6H, 3RH, 2RZ and NT. There were 11 cases of tuberculosis during the follow-up period. The tuberculosis rates (cases per 100 person-years) were 3.4, 3.1, 1.2 and 3.1 for 6H, 3RH, 2RZ and NT respectively, with relative risks in regimens 6H, 3RH and 2RZ with respect to NT of 1.07 (0.24-4.80), 0.98 (0.22-4.4) and 0.39 (0.04-3.48), all statistically non-significant. Twenty-nine patients died during the follow-up period, none due to tuberculosis, and no appreciable differences were found among the groups. CONCLUSIONS: The results showed no significant decrease in the risk of developing tuberculosis with any of the evaluated regimens and, therefore, do not support the use of antituberculosis chemoprophylaxis in anergic HIV-infected patients.

Ensayo clínico aleatorizado de tres pautas de quimioprofilaxis para prevenir la tuberculosis en pacientes infectados por el VIH con anergia cutánea / Randomized trial of three regimens to prevent tuberculosis in HIV-infected patients with anergy

INTRODUCCIÓN. Evaluar la eficacia de tres pautas de quimioprofilaxis antituberculosa en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) con anergia cutánea. MÉTODOS. Ensayo clínico prospectivo, multicéntrico, aleatorizado, comparativo y abierto. La anergia cutánea se definió por la ausencia de reactividad a 3 antígenos aplicados por la técnica de Mantoux (PPD, candidina y parotiditis). Los pacientes se distribuyeron de forma aleatoria a uno de los siguientes grupos de tratamiento: isoniacida durante 6 meses (6H), rifampicina más isoniacida, 3 meses (3RH), rifampicina más piracinamida, 2 meses (2RZ) o sin tratamiento (NT). Tras finalizar la quimioprofilaxis los pacientes fueron seguidos 2 años. ESULTADOS. Se incluyeron en el estudio 319 pacientes, 83 en la pauta 6H, 82 en 3RH, 77 en 2RZ y 77 en NT. El período de observación tras el tratamiento fue de 88, 96, 81 y 126 personas años, respectivamente para 6H, 3RH, 2RZ y NT. Se produjeron 11 casos de tuberculosis durante el seguimiento. Las tasas de tuberculosis (casos por 100 personas/año) fueron respectivamente de 3,4, 3,1, 1,2 y 3,1 para 6H, 3RH, 2RZ y NT, con un riesgo relativo en las pautas 6H, 3RH y 2RZ respecto a NT de 1,07 (0,24-4,80), 0,98 (0,22-4,4) y 0,39 (0,04-3,48), estadísticamente no significativo. Durante el seguimiento fallecieron 29 pacientes, ninguno de ellos por tuberculosis, sin que se apreciaran diferencias entre grupos. CONCLUSIONES. Nuestro estudio no demuestra una reducción significativa del riesgo de tuberculosis en ninguna de las 3 pautas evaluadas y, por tanto, no apoya el empleo de quimioprofilaxis antituberculosa en pacientes con anergia cutánea (AU)

Evaluation of two inhibitors of invasion: LY311727 [3-(3-acetamide-1-benzyl-2-ethyl-indolyl-5-oxy)propane phosphonic acid] and AEBSF [4-(2-aminoethyl)-benzenesulphonyl fluoride] in acute murine toxoplasmosis.

We examined the effect of an inhibitor of secretory phospholipase A2 type II (LY311727) and of a specific inhibitor of serine proteases (AEBSF) in a murine model of acute toxoplasmosis. LY311727 did not afford any significant protection and produced earlier mortality compared with untreated mice at a dose of 100 mg/kg. In contrast, AEBSF demonstrated a significant increase in length of survival, and this effect was enhanced when AEBSF was administered with non-protective doses of pyrimethamine.

Enfermedad de Legg-Calvé-Perthes: diagnóstico y evaluación del pronóstico por medio de imágenes diagnósticas / Legg-Calve-Perthes disease: Diagnosis and Evaluation of Prognosis Through Images

La enfermedad de Legg-Calvé-Perthes es una patología que se presenta en la infancia, con secuelas como deformidad de la cabeza femoral, cojera y acortamiento del miembro inferior afectado. Se ha tratado de establecer la forma de realizar un diagnóstico precoz con la ayuda de imágenes diagnósticas y se ha comprobado que la gammagrafía y la resonancia nuclear magnética son los métodos imagenológicos que dan una mejor idea temprana del estado de la cabeza femoral afectada por el proceso de osteonecrosis. Además, las clasificaciones descritas por múltiples autores, buscan la forma de establecer un pronóstico de la evolución de la enfermedad para así establecer el tratamiento adecuado. En la actualidad, lo que se busca es unificar los criterios y establecer una clasificación única integrando los diferentes métodos diagnósticos para evitar secuelas en los niños afectados por esta enfermedad

Acidente vascular cerebral isquêmico / Ischemic cerebrovascular accident

O Acidente Vascular Cerebral Isquêmico (AVCI) representa a maior causa de hospitalizaçao por problemas neurológicos agudos e ocupa o terceiro lugar no obituário de nosso país e países ocidentais. Esta taxa é sobrepujada, apenas, pelas patologias cardíacas e câncer. Devido ao seu alto índice de morbiletalidade, torna-se fundamental o esclarecimento dessa patologia com o intuito de aprimorar os conhecimentos sobre o seu diagnóstico e a sua terapêutica. Os autores revisaram a literatura e demonstraram os principais aspectos do AVCI, enfatizando a epidemiologia, os fatores de risco, a fisiopatologia, as manifestaçoes clínicas, o diagnóstico e o tratamento desta doença.

Utilización del ozono como agente desinfectante de aguas contaminadas con salmonellas / Use of ozone as disinfectant agent in water containated by salmonellas

Se señala que la eliminación de gérmenes patógenos, tanto de alimentos como del agua, es un aspecto de gran importancia por la afectación económica y social que esto ocasiona. Se estudian las posibilidades de inactivación de la Salmonella del agua mediante el empleo de ozono, pues a pesar de estar comprobadas las propiedades germicidas de éste, no se dispone de la información acerca de su acción sobre la Salmonella que posibilite su aplicación en sustitución de otros compuestos utilizados en diferentes procesos industriales, los cuales son poco efectivos frente a este tipo de infección. Se comprobó que es posible inactivar el 100 de las células de Salmonella mediante la aplicación de ozono en diferentes tiempos, en dependencia de la concentración aplicada

Utilización del ozono como agente desinfectante de aguas contaminadas con salmonellas / Use of ozone as disinfectant agent in water contaminated by salmonellas

Se señala que la eliminación de gérmenes patógenos, tanto de alimentos como del agua, es un aspecto de gran importancia por la afectación económica y social que esto ocasiona. Se estudian las posibilidades de inactivación de la Salmonella del agua mediante el empleo de ozono, pues a pesar de estar comprobadas las propiedades germicidas de éste, no se dispone de la información acerca de su acción sobre la Salmonella que posibilite su aplicación en sustitución de otros compuestos utilizados en diferentes procesos industriales, los cuales son poco efectivos frente a este tipo de infección. Se comprobó que es posible inactivar el 100 de las células de Salmonella mediante la aplicación de ozono en diferentes tiempos, en dependencia de la concentración aplicada